One day when I was a medical student, on placement in a gynaecology clinic, a woman came in in tears.
She was so embarrassed she found it difficult to explain what the problem was. Eventually, she described how she’d found a ‘lump in her underwear’ and had cried every day believing she was the only person in the world to have such a problem.
The lump had seriously impacted her wellbeing; she’d avoided sex with her husband and had experienced bleeding and discomfort from the lump. It had taken her two years to find the courage to see a GP who had referred her to see a gynaecologist.
When we examined her, we saw she had a uterine prolapse, where weakness in the muscles of her vagina had caused her uterus to descend. The lump she had felt was actually her uterus.
The doctor was able to insert a pessary – a plastic ring – into the vagina, returning the uterus to its correct position, which only took a few minutes.
In an instant, something that she had suffered in silence with for two years was treated and she couldn’t stop smiling. I’ll never forget it.
What really struck me about this woman’s experience was the level of stigma surrounding gynaecological issues and how that can ultimately lead to women feeling uncomfortable speaking out despite the pain and discomfort they are experiencing.
I’m sure this woman doesn’t realise it, but she’s the reason I decided to specialise in gynaecology and women’s health.
Silence, stigma, myths and misinformation can make navigating healthcare for women and girls incredibly challenging.
Stigma has derived from gender inequality and the discrimination women have faced for years and years. They have been told by society that their health is something to be ashamed of; periods are seen as dirty, menopause seen as embarrassing and unwanted pregnancies not to be discussed. As a result, internalised biases can prevent women them from accessing information and care.
It’s disgraceful that attitudes like this still exist in 2021 and even worse, continue to be perpetuated by cultural taboos, lack of information and poverty.
Another barrier is that when healthcare systems were designed, women’s needs weren’t prioritised and therefore this often means that conditions that only affect women are under-researched, or how conditions impact on women specifically are not understood – which can lead to longer diagnosis times and a poorer patient experience.
In the Royal College of Obstetricians and Gynaecologists’ (RCOG) Better For Women report in 2019, we called on the government to introduce a Women’s Health Strategy. The aim was to ensure that women’s wellbeing, not just their reproductive health during pregnancy, become priorities throughout their lives.
We are incredibly pleased to see the Government announce it will be making this a reality in England.
The Government launched a call for evidence for the development of a strategy in March, to mark International Women’s Day. The consultation was open for nearly three months, with over 100,000 responses from people and expert organisations (like RCOG) to feed in their experiences and expertise to help shape the strategy.
Now, the Government will review all of the content received through the call for evidence and use it to write a strategy.
What’s crucial is that this strategy puts women’s voices at the centre of their health and care.
RCOG’s response call set out an approach for women’s voices to be included in the governance and leadership of all parts of the health services – from primary care to specialist services.
The RCOG is calling on the Government to make sure that women don’t have to face any stigma accessing the right care and support, and that when they do seek help they feel listened to and empowered by medical professionals.
It’s also important that in the future all women, whatever their background, can access trusted and comprehensive information on their health. This includes educating all young people from an early age about periods, fertility and the menopause.
A survey found that the most common barriers women face in accessing information and support in relation to their health was time, and discerning the quality and trustworthiness of the information.
When I fell pregnant myself, as an obstetrics doctor, I noticed so many changes happening to my body that I hadn’t expected. I was in a fortunate position to understand the changes, because of my medical education and experience, but many of my friends who were also pregnant felt confused and had no idea what to expect.
Nowadays, people naturally turn to social media to help them navigate this strange and sometimes scary time. However, the information they find isn’t always factually correct.
That’s why I set up my Instagram account, @theobgynmum, to provide evidence-based information about pregnancy, fertility and birth.
By helping people understand their bodies better, they feel more empowered to ask questions, seek help when problems arise, but also feel reassured when the things they notice are normal.
The Covid-19 pandemic has both exacerbated and further exposed the stark inequalities in health in this country – for example, pregnant women hospitalised with symptomatic coronavirus infection are more likely to be from a Black, Asian or other minority ethnic background.
Significant racial disparities in women’s healthcare exist; it is unacceptable in this day and age, and ending these inequalities must be a central objective of the Women’s Health Strategy.
From my own personal experience working on a labour ward, one of the daily challenges we face is making sure that our care is equally delivered to people of all ethnicities and in all languages.
When the ward is busy, and the stakes are high with needing to make rapid decisions, it can be very difficult to deliver high-quality care when you don’t have the time to understand someone’s cultural background. Some cultures may not discuss childbirth, or put a disproportionate value on vaginal birth.
There are others who want contraception but know it would be unacceptable in their religion. That’s why it’s so crucial that this strategy explicitly outlines plans to understand, reduce and eliminate inequalities in access, experience and outcomes for women.
The strategy will be published by the end of 2021 and we hope to see the Government implementing these actions as soon as possible to improve women’s health in England.
As a doctor and a woman, I’m excited at the prospect of having a healthcare system that works for everyone.
To read the RCOG’s full response to the Women’s Healthcare Strategy visit here.
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